No abstract available.
Thrombosis*

No abstract available.
Pneumothorax* ; Thoracotomy*

OBJECTIVE: We analyzed the clinical features of amniotic fluid embolism confirmed by autopsy or clinical dicision for making a plan of rapid diagnosis and intensive emergency care. STUDY DESIGN: We experienced 2 clincal cases in Ewha Mokdong Hospital and Severance Hospital at 1995, and reviewed the medical record & autopsy report of 15 cases in National Institute of Scientific Investigation from Jan, 1991 to Dec, 1995. RESULTS: The mean maternal age was 31+/-3 years. The mean gestational age was 40+/-1 weeks. The number of delivery were 1.4+/-0.8. The number of abortion history. were 2.6+/-2. The sexuality of fetus were six males (35 %), five females (29%), and unknown six cases (35 %) and the fetal mortality rate was 29 % (5 cases). The initial clinical symptoms and signs were hypotension (12 patients, 71%), vaginal bleeding(ll patients, 65%), cardiac arrest (6 patients, 35 %), dyspnea (5 patients, 29 %), and seizure (2 patients, 12%). In the case of normal spontaneous vaginal delivary (NSVD), the symptoms occurred during induction in 3 (18%), during delivery in 1 (6%), and after delivery in 9 (53%). In the case of Cesarean section, the symptoms occurred during section in 2 (12%), and after section in 1 (6%). There are one case whose symptoms occurred during 3rd gestational period. CONCLUSIONS: We should alert for the amniotic fluid embolism in the clinical findings of acute collapse and vaginal bleeding, respiratory symptoms, and seizure at any peripartum. With eary suspicion of this disease and aggressive intensive care we can reduce amniotic fluid embolism mortality rate and it's legal problem.
Abortion, Induced ; Amniotic Fluid* ; Autopsy ; Cesarean Section ; Diagnosis ; Dyspnea ; Embolism, Amniotic Fluid* ; Emergency Medical Services ; Female ; Fetal Mortality ; Fetus ; Gestational Age ; Heart Arrest ; Humans ; Hypotension ; Critical Care ; Male ; Maternal Age ; Medical Records ; Mortality ; Peripartum Period ; Pregnancy ; Seizures ; Sexuality ; Uterine Hemorrhage

BACKGROUND: The multifactorial hypothesis is proposed as a working hypothesis which encompass both the genetic and environmental factors known to participate in the etiology of congenital heart anomalies. So, at the moment, it is believed that avoidance of suspected environmental factors in early pregenancy is most certain preventive measure of congenital heart anomalies. This study has been undertaken in order to find the possible environmental risk factors for congenital heart anomalies in Korea. METHOD: A total of 320 mothers of infants with congenital heart anomalies diagnosed at Seoul National University Hospital were included in this study as case group. And 413 mothers of healthy infants, who visited well baby clinic at the hospital during the same period of 2 years from 1987, comprised the control group. Data related to environmental risk factors including drug use during the first trimester of pregnancy, any other confounders were collected by direct interview using questionmaires. RESULT: There were positive associations for lower educational level of mother, indoor smoking habit of father, number of pregnancy, and of experience of previous abortion of mother, and multiple(or twin) birth. Relative risk estimates for the first trimester exposure to anti-emetics and herb medicine were 2.1(p<0.006) and 1.4(p<0.044), respectively. Data showed a positive association between anti-inflammatory drug exposure and congenital anomalies of pulmonary valve(OR=22.7, p<0.01), and between anti-histamine exposure and coarctation of aorata(OR=12.7, p<0.017). CONCLUSION: Environmental factors such as smoking habit of father, certain drugs used in early pregnancy, plays a role in the etiology of congenital heart anomlaies. Further studies, designed to focus on specific drug and to differentiate the effect of the suspected drug and to differentiate the effect of the suspected drug form that of the underlying conditions prompting its use, should be called upon.
Abortion, Induced ; Antiemetics ; Case-Control Studies* ; Fathers ; Female ; Heart* ; Humans ; Infant ; Korea* ; Mothers ; Parturition ; Pregnancy ; Pregnancy Trimester, First ; Risk Factors ; Seoul ; Smoke ; Smoking

BACKGROUND: Anorectal procedures are performed in the jack-knife position. The combined use of midazolam and spinal anesthesia is common in clinical practice. Despite the known potential for each to alter ventilation, the effect of their interaction under jack-knife position has not been examined. METHODS: In a prospective, double-blind, and randomized study, forty patients (four groups, n=10 each, saline-supine position group, saline-jack-knife position group, midazolam-supine position group and midazolam-jack-knife position group) were examined. The effect of intravenous midazolam (0.05 mg/kg) for sedation, spinal anesthesia (hyperbaric tetracaine, below T8), position (jack-knife position or supine position during operation), and their combination on mean arterial pressure, arterial oxygen saturation (SpO2), PaO2, PaCO2, respiratory rate were evaluated. Incidence of hypoxemia was measured by pulse oximetry (SpO2 less than 90% for 30 seconds or longer). RESULTS: The incidence of hypoxemia in the midazolam-supine position group was 20%. There was no patient showing hypoxemia in other groups. After spinal anesthesia, there were no significant differences of mean arterial pressure, arterial oxygen saturation, PaO2, PaCO2, respiratory rate between supine and jack-knife position. The combination of jack-knife position and midazolam caused a significant increase of PaCO2 (9% of baseline value). Cardiovascular side effects such as hypotension or other reactions such as vomiting, nausea, or confusion were not observed after midazolam. At the end of the operation, all patients were fully awake and cooperative. CONCLUSIONS: Intravenous midazolam (0.05 mg/kg) may produce hypoxemia (SpO2<90%) during spinal anesthesia in supine position. In the jack-knife position, intravenous midazolam caused increase of the arterial CO2 tension. Monitoring of arterial blood oxygen saturation is mandatory in patients with spinal anesthesia and midazolam sedation during supine position.
Anesthesia, Spinal* ; Anoxia ; Arterial Pressure ; Humans ; Hypotension ; Incidence ; Midazolam* ; Nausea ; Oximetry ; Oxygen* ; Prospective Studies ; Respiratory Rate* ; Supine Position ; Tetracaine ; Ventilation ; Vomiting

This cross-sectional survey was carried out to assess the decisional balance of Korean women toward mammography screening. A sample of 1, 903 naturally postmenopausal women was selected from the community-based social groups in town or city hall auxiliaries in seven metropolitan areas and six provinces in Korea. The classification of women according to the stage of adoption of mammography was 54.9% in pre-contemplation, 31.9% in contemplation, 7.8% in action, and 5.5% in maintenance. The mean differences of pros, cons, and the decisional balance by the stage of mammography adoption were statistically significant. There were significant mean differences between the stages of adoption according to a woman's experience with and intention for mammography and the pros score, the cons score, and the decisional balance score. Results provide the empirical evidence for the Transtheoretical model. An association between stages of mammography adoption and decisional balance exists.
Classification ; Cross-Sectional Studies ; Female ; Humans ; Intention ; Korea ; Mammography* ; Mass Screening*

Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.
Adrenal Insufficiency ; Adrenocorticotropic Hormone* ; Anemia ; Brain ; Fatigue ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperprolactinemia* ; Hypoglycemia ; Hyponatremia ; Hypotension ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nausea ; Pallor ; Pituitary Hormones, Anterior ; Plasma ; Prolactin ; Vomiting ; Water ; Weight Loss

BACKGROUND: Although the effect of clonidine, an alpha2 adrenoreceptor agonist, is well established, there is no study to evaluate the effects of addition of clonidine to ldegrees Cal anesthetics in elderly hypertensive patients. The aim of this study is to evaluate the effects of addition of clonidine to ldegrees Cal anesthetics in elderly hypertensive patients undergoing senile cataract surgery. METHODS: Forty elderly hypertensive patients who scheduled for elective senile cataract surgery were divided into two groups. The control group (n=20) received oral diazepam 0.1 mg/kg 60 min before surgery and the clonidine group (n=20) did not received premedication. A mixture of 2% liddegrees Caine and 0.5% bupivacaine with normal saline 0.7 ml (control group) or clonidine 100 ug (clonidine group) was used as a ldegrees Cal anesthetics. Perioperative blood pressure, heart rate, sedation score, and intradegrees Cular pressure were measured. RESULTS: After anesthesia, there was a significant fall in blood pressure and intradegrees Cular pressure in clonidine group, and increase in sedation score in clonidine group than control group. There was no difference in the perioperative heart rate between the two groups. CONCLUSIONS: The above results show that addition of clonidine to ldegrees Cal anesthetics in elderly hypertensive patients undergoing senile cataract surgery produced reduction in blood pressure, intradegrees Cular pressure and produced intraoperative sedation.
Aged ; Anesthesia ; Anesthetics* ; Blood Pressure ; Bupivacaine ; Cataract* ; Clonidine* ; Diazepam ; Heart Rate ; Humans ; Premedication

PURPOSE: This study was to examine the effects of Taping therapy on the deformed angle of the foot and pain in hallux valgus patients. METHOD: The subjects were 24 feet from 15 patients who were diagnosed withhallus valgus at the orthopedic department of K University Hospital in Seoul. Taping therapy was conducted 15 times overall during a four-week period. Data was analyzed using descriptive statistics and t-test. RESULT: The deformed angle of the foot of the hallus valgus patients significantly improved from 21.95(4.38) to 18.75(4.80) after Taping therapy. Pain significantly decreased from 4.73(1.56) to 3.45(2.21) after Taping therapy. CONCLUSION: The result shows that Taping therapy is effective in improving the deformed angle of the foot and in decreasing pain in the hallux valgus patients.
Adult ; Female ; Hallux Valgus/*therapy ; Humans ; Middle Aged ; *Orthotic Devices ; Pain

BACKGREOUND: Tuffier's line has been a guide for lumbar puncture. Usually lumbar puncture or epidural anesthesia was performed in the lateral decubitus position with the "forehead-to-knees" position. The purpose of this study was to identify the accuracy with which the spinal level could be predicted from this external mark in the "forehead-to-knees" position. METHODS: Two hundred and twenty-four patients (112 male and 112 female patients) undergoing investigation for back pain were examined. The standard antero-posterior lumbar spine film was taken in the supine position. The lateral lumbar spine film was taken in the lateral decubitus with the "forehead-to-knees" position. These films were examined after being reported upon by a radiologist. The iliac crest was identified and a horizontal line drawn between the highest points using a ruler. The level of Tuffier's line of each age group in supine or "forehead-to-knees" position and relationship with aging were observed. RESULTS: The point coincided with the L4-5 interspace (61%), L4 (20%), and L5 (19%) in the supine, L4-5 (48%), L5 (46%), L4 (5%), and L5S1 (0.4%) in the "forehead-to-knees" position. The Tuffier's line of men were higher than women. The Tuffier's line in the "forehead-to-knees" position went higher with aging in women. CONCLUSIONS: The Tuffier's line was most frequently the L4-5 interspace in supine and "forehead-to-knees" positions. The Tuffier's line in the "forehead-to-knees" was lower than the supine position. The Tuffier's line of men were higher than women of all age groups in the supine position. The Tuffier's line in the "forehead-to-knees" position went higher with aging in women. The Tuffier's line in the supine position in women and of both positions in men did not show any relation with age.
Adult* ; Aging ; Anesthesia, Epidural ; Back Pain ; Female ; Humans ; Male ; Spinal Puncture ; Spine ; Supine Position